Impact of Oscillating Positive Expiratory Pressure Device Use on Post-Discharge Hospitalizations: A Retrospective Cohort Study Comparing Patients with COPD or Chronic Bronchitis Using the Aerobika® and Acapella® Devices

Background: Limited information exists in neurosurgery regarding the association between functional status at hospital discharge and adverse events following discharge. Methods: A retrospective cohort study included all adults in one Boston teaching hospital who underwent neurosurgery between 2000-2012, survived hospitalization and had a Physical Therapist functional status assessment within 48-hours of discharge. 90-day post-discharge all-cause mortality was obtained from the US Social Security Administration Death Master File. Logistic regression analysis was used. Results: 2,369 patients were included, comprising 65% cranial and 35% spinal. Malignancy and trauma was 47% and 13%, respectively. 238 patients had independent functional status. 90-day mortality and readmission was 8.3% and 28%, respectively. Second, third and lowest quartile of functional status was associated with a 3.16 (95%CI 1.08-9.24), 6.00 (2.11-17.04) and 6.26 (2.16-18.16) respective increased odds of 90-day post-discharge mortality compared to patients with independent functional status, adjusting for age, gender, race, length of stay, presence of malignancy and Deyo-Charlson comorbidity. Good discrimination (AUC 0.82) and calibration (Hosmer-Lemeshow χ2 P = 0.23) were demonstrated. Adjusted odds of 90-day readmission in patients with the lowest quartile of functional status was 1.89 (1.28-2.80) higher than patients with independent functional status. Conclusions: Lower functional status at hospital discharge following neurosurgery is associated with increased post-discharge mortality and hospital readmission.

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Persistence with opioids post discharge from hospitalisation for surgery in Australian adults: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2018-023990 ◽

2019 ◽

Vol 9 (4) ◽

pp. e023990 ◽

Cited By ~ 11

Author(s):

Elizabeth Ellen Roughead ◽

Renly Lim ◽

Emmae Ramsay ◽

Anna K Moffat ◽

Nicole L Pratt

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Opioid Therapy ◽

Health Claims ◽

Post Discharge ◽

Opioid Prescription ◽

Discharge From Hospital ◽

Surgical Admission

ObjectiveTo determine time to opioid cessation post discharge from hospital in persons who had been admitted to hospital for a surgical procedure and were previously naïve to opioids.Design, setting and participantsRetrospective cohort study using administrative health claims database from the Australian Government Department of Veterans’ Affairs (DVA). DVA gold card holders aged between 18 and 100 years who were admitted to hospital for a surgical admission between 1 January 2014 and 30 December 2015 and naïve to opioid therapy prior to admission were included in the study. Gold card holders are eligible for all health services that DVA funds.Main outcome measuresThe outcome of interest was time to cessation of opioids, with follow-up occurring over 12 months. Cessation was defined as a period without an opioid prescription that was equivalent to three times the estimated supply duration. The proportion who became chronic opioid users was defined as those who continued taking opioids for greater than 90 days post discharge. Cumulative incidence function with death as a competing event was used to determine time to cessation of opioids post discharge.ResultsIn 2014–2015, 24 854 persons were admitted for a surgical admission. In total 3907 (15.7%) were discharged on opioids. In total 3.9% of those discharged on opioids became chronic users of opioids. The opioid that the patients were most frequently discharged with was oxycodone; oxycodone alone accounted for 43%, while oxycodone with naloxone accounted for 8%.ConclusionsOpioid initiation post-surgical hospital admission leads to chronic use of opioids in a small percentage of the population. However, given the frequency at which surgical procedures occur, this means that a large number of people in the population may be affected. Post-discharge assessment and follow-up of at-risk patients is important, particularly where psychosocial elements such as anxiety and catastrophising are identified.

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